Provider Demographics
NPI:1164782595
Name:VINE& BRANCH HOMECARE
Entity Type:Organization
Organization Name:VINE& BRANCH HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:MARYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-906-6482
Mailing Address - Street 1:4258 HIGHWAY 49 S
Mailing Address - Street 2:SUITE 901
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7558
Mailing Address - Country:US
Mailing Address - Phone:910-331-6088
Mailing Address - Fax:
Practice Address - Street 1:2520 SARDIS RD N
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7827
Practice Address - Country:US
Practice Address - Phone:704-246-8725
Practice Address - Fax:704-246-8728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health